Early Outcomes From the English National Health Service Diabetes Prevention Programme

Abstract

To assess weight and HbA 1c changes in the Healthier You: National Health Service Diabetes Prevention Programme (NHS DPP), the largest DPP globally to achieve universal population coverage. RESEARCH DESIGN AND METHODS A service evaluation assessed intervention effectiveness for adults with nondiabetic hyperglycemia (HbA 1c 42-47 mmol/mol [6.0-6.4%] or fasting plasma glucose 5.5-6.9 mmol/L) between program launch in June 2016 and December 2018, using prospectively collected, national service-level data in England.

Improving prevention strategies for cardiometabolic disease

“…At the same time, there has been progress in diabetes prevention. Early examination of the English diabetes prevention programme shows good weight loss in individuals adhering to the programme but improvements in program engagement, retention and completion are required 13 . Currently, the focus of these programmes is to identify those at highest risk and introduce lifestyle changes to slow or halt progression to diabetes.…”

Why the NHS Diabetes Prevention Programme isn't resting on its laurels

“…The combination of dietary modification and exercise also reduced the number of microvascular complications (by 35%), cardiovascular deaths (by 33%), cardiovascular disease events (by 26%) and all‐cause deaths (by 26%), while increasing average life expectancy by 1.44 years . A systematic review commissioned by Public Health England to inform the design of the NHS DPP found that lifestyle interventions reduced weight by an average 2.5kg, HbA 1c by 0.8mmol/mol and T2D incidence by 26% compared with usual care …”

“…An intention‐to‐treat analysis reported a mean weight loss of 2.3kg and an HbA 1c reduction of 1.26mmol/mol. Among participants who completed the programme, defined as attending more than 60% of sessions, mean weight loss was 3.3kg with an HbA 1c reduction of 2.04mmol/mol …”

“…Younger people, females, those of Asian and black ethnicity or lower socioeconomic status, or with normal baseline BMI tended to lose less weight. Older people, females, those of black ethnicity, lower socioeconomic status or who were overweight or obese at baseline showed smaller HbA 1c reductions . Many of these groups – people from areas of socioeconomic deprivation, for example – are also those most likely to be obese and have T2D.…”

“…The analysis of the first 2.5 years of the NHS DPP found that 53% and 36% of people referred attended the initial assessment and at least one group‐based session respectively. Nineteen percent completed the intervention, defined as attending more than 60% of sessions . ‘Fitting in 13 sessions around work and family commitments is not always easy, particularly among younger people,’ Ms Joule says.…”